Demographic and Burn Injury-Specific Variables Associated with Limited Joint Mobility at Discharge in a Multicenter Study

2020 ◽  
Vol 41 (2) ◽  
pp. 363-370 ◽  
Author(s):  
Jonathan Lensing ◽  
Lucy Wibbenmeyer ◽  
Junlin Liao ◽  
Ingrid Parry ◽  
Karen Kowalske ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Burn Injury ◽  
Limited Range ◽  
Joint Motion ◽  
Patient Acuity ◽  
Related Factors ◽  
Limited Joint Mobility ◽  
Burn Scar ◽  
Rehabilitation Treatment ◽  
Limited Range Of Motion

Abstract Burn scar contractures. Existing research on contractures is limited by incomplete analysis of potential contributing variables and differing protocols. This study expands the exploration of contributing variables to include surgery and rehabilitation treatment-related factors. Additionally, this study quantifies direct patient therapy time and patient exposure to rehabilitation prevention therapies. Data from subjects enrolled in the prospective Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) were analyzed to determine variables related to a limited range of motion (limROM) in seven joints and 18 motions (forearm supination) at discharge. Chi-squared and Student’s t-test were used accordingly. Multivariate analysis was performed at the patient and joint motion level to control for confounders. Of the 300-member study group, 259 (86.3%) patients had limROM at discharge. Variables independently related to the development of moderate-to-severe limROM on the patient level were larger TBSA, having skin grafted and prolonged bed rest. Variables independently related to moderate–severe limROM on the joint motion level were the percentage of cutaneous functional unit (CFU) burned (P = .044), increase in the length of stay, weight gain, poor compliance with rehabilitation therapy and lower extremity joint burns. Rates of limROM are increased in patients who had larger burns, required surgery, had a greater percentage of the associated CFU burned, and had lower extremity burns. Attention to adequate pain control to ensure rehabilitation tolerance and early ambulation may also decrease limROM at discharge and quicker return to pre-burn activities and employment.

Update on the practice of splinting during acute burn admission from the ACT study

2021 ◽  
Author(s):  
Desmond Khor ◽  
Junlin Liao ◽  
Zachary Fleishhacker ◽  
Jeffrey C Schneider ◽  
Ingrid Parry ◽  
...  
Keyword(s):  
Current Practice ◽  
Injury Severity ◽  
Burn Injury ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Hospital Length Of Stay ◽  
Patient Acuity ◽  
Burn Scar ◽  
Rehabilitation Treatment ◽  
Scar Contracture

Abstract Introduction Burn scar contracture (BSC) is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in function. Despite a paucity of research addressing its efficacy, static splinting of affected joints is a common preventative practice. A survey of therapists performed 25 years ago showed a widely divergent practice of splinting during the acute burn injury. We undertook this study to determine the current practice of splinting during the index admission for burn injuries. Methods This is a review of a subset of patients enrolled in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database. ACT was an observational multicenter study conducted from 2010-2013. The most commonly splinted joints (elbow, wrist, knee and ankle) and their 7 motions were included. Variables included patients’ demographics, burn variables, rehabilitation treatment and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P< 0.05 was significant. Results Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. Splinting was associated with larger burns and increased injury severity on the patient level and increased involvement with burns requiring grafting in the associated cutaneous functional unit (CFU) on the joint level. The requirement for skin grafting in both analyses remained independently related to splinting, with requirement for grafting in the associated CFU increasing the odds of splinting 6 times (OR =6.0, 95% CI=3.8-9.3, p<0.001). On average splinting was initiated about a third into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50 ± 26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. The wrist was most frequently splinted joint being splinted with one third of wrists splinted ( 30.7%) while the knee was the least frequently splinted joint with 8.2% splinted. However, when splinted, the knee was splinted the most hours per day (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). Almost one third had splinting continued to discharge (20, 27%). Conclusions The current practice of splinting, especially the initiation, hours of wear and duration of splinting following acute burn injury remains variable. Splinting is independently related to grafting, grafting in the joint CFU, larger CFU involvement and is more likely to occur around the time of surgery. A future study looking at splinting application and its outcomes is warranted.

scholarly journals PENGARUH TERAPI LATIHAN DAN PEMASANGAN BANDAGE PADA CONGENITAL TALIPES EQUINO VARUS BILATERAL DI YPAC SEMARANG : LAPORAN KASUS

2019 ◽  
Vol 3 (2) ◽  
pp. 41-47
Author(s):  
Didik Purnomo ◽  
Irawan Wibisono ◽  
Rahma Nurwidianti
Keyword(s):  
Limited Range ◽  
General Term ◽  
Joint Motion ◽  
Normal Position ◽  
Old Patients ◽  
Limited Range Of Motion ◽  
Tibialis Muscle ◽  
Motion Range ◽  
Bilateral Case ◽  
Congenital Talipes

Background : Congenital Talipes Equino Varus (CTEV) or commonly called Clubfoot is a general term used to describe a general deformity which is foot changes from its normal position. Problems that occur in the Congenital Talipes Equino Varus Bilateral case are the limited range of motion on both ankles, the presence of contractures in the posterior tibialis muscle. Physiotherapy role by providing modalities such as bandage usage, stretching, wall bars exercise, parallel bars exrcise and easy standing exercise.Case Presentation : Patients in this case were 9-year-old women using interventions in the form of bandage usage, wall bars exercise, parallel bars exrcise and easy standing exercise for 6 sessions.Method : This case report assesses the patient's joint motion range by measuring differences between pre-test and post-test.Results: Patients do not improved in the ankle range of motion.Conclusion : In this case, it was shown that exercise therapy given and bandage usage on 9-year-old patients with CTEV conditions could not change the patient's ankle range of motions.

644 Use of Plantar Foot Plate Splints and High-Profile Leg Net Devices for Prevention of Plantarflexion Contracture following Placement of Cultured Epidermal Autograft to Lower Extremities

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S178-S179
Author(s):  
Brooke Dean ◽  
Gregory Andre ◽  
Scott F Vocke
Keyword(s):  
Lower Extremity ◽  
Burn Injury ◽  
Lower Extremities ◽  
Ankle Dorsiflexion ◽  
Burn Scar ◽  
Thermoplastic Material ◽  
Scar Contracture ◽  
High Profile ◽  
Left Ankle

Abstract Introduction Burn Therapists strive to prevent burn scar contracture through positioning strategies beginning in the acute phase of burn injury. This task is even more challenging when paired with posterior offloading and joint immobilization required for the viability of cultured epidermal autograft (CEA). High profile leg net devices are the standard for posterior offloading after application of CEA circumferentially to lower extremities but can result in poor positioning of the ankle. Custom foot plate splints were designed and fabricated to preserve ankle dorsiflexion during the initial stages of CEA healing. Methods The high-profile leg net devices were assembled using 3/4 inch PVC piping and PVC fittings (45 degrees, 90 degrees, and tees) with double layered elastic tubular netting to allow proper wound ventilation while supporting the lower extremity with the patient in supine. The plantar foot plates were custom molded to the patient’s foot using thermoplastic material and lined with medium density temper foam for pressure relief. The foot plate was attached to the frame using Velcro and straps. Instructions with photographs were posted in the patient’s room for nursing staff to reference. Netting was exchanged daily and frames were disinfected using standard techniques. Results Goniometric measures were taken for ankle dorsiflexion were taken on day of CEA application with lower extremities positioned on high profile nets (in alignment with cutaneous functional unit modified position): -6 degrees right ankle, -2 degrees left ankle. Repeat measures were taken after one week period of bilateral lower extremity immobilization per CEA protocol: -1 degree right ankle, 2 degrees left ankle. One month follow-up at the discontinuance of leg net devices showed bilateral ankle dorsiflexion preserved with 3-degree right ankle dorsiflexion and 5 degrees on the left. Conclusions The use of custom foot plates on high profile leg net devices appears to improve ankle dorsiflexion range of motion while maintaining adequate posterior offloading required for CEA precautions for a burn survivor with extensive lower extremity burn wounds.

121 25 years later: Has the Practice of Splinting Burned Joints Changed?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S80-S81
Author(s):  
Desmond Khor ◽  
Junlin Liao ◽  
Karen J Kowalske ◽  
Ingrid Parry ◽  
Jeffrey C Schneider ◽  
...  
Keyword(s):  
Current Practice ◽  
Skin Grafting ◽  
Hospital Length ◽  
Burn Injuries ◽  
Hospital Length Of Stay ◽  
Patient Acuity ◽  
Burn Scar ◽  
Rehabilitation Treatment ◽  
Scar Contracture ◽  
Burn Centers

Abstract Introduction Burn scar contracture (BSC) across joints is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in activities of daily living (ADLs). Despite a paucity of research addressing it efficacy, static splinting of burned joints is a common preventative practice. A survey of burn centers performed 25 years ago showed a widely divergent practice of splinting. We undertook this study to determine the current practice of splinting in acute burn injuries. Methods This is a retrospective observational study of 246 patients who were included in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database from 2010–2013. The most commonly splinted joints (elbow, wrist, knee and ankle) and their 8 motions were included. Variables included patients’ demographics, burn variables, rehabilitation treatment and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P< 0.05 was significant. Results Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. On average splinting was initiated about a third of the way into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50±26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. Joints with higher amounts of burn involvement and need for grafting to their associated cutaneous functional units (CFU) were more likely to be splinted (p< 0.001). The wrist was most frequently splinted (30.7%) while the knee was the least frequently splinted joint (8.2%). The knee was splinted the longest (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). One third had splinting continued to discharge (20, 27%). The requirement for skin grafting in the associated CFU was the only factor that was independently related to splinting, increasing the odds of splinting 2% for every 1% of CFU grafted (adj OR =1.02, 95% CI=1.01–1.03, p< 0.001). Conclusions The current practice, especially the timing, hours of wear and duration of splinting following burns remains diverse among burn centers. Splinting is more common in joints that have more burn and deeper burns require grafting in the associated CFU; otherwise there appears to be little consensus in the practice of splinting. Future study looking at splinting application and its outcomes is warranted.

76 The Effect of Splinting of Metacarpophalangeal Joints After Skin Grafting: A Review of the ACT Database

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S49-S50
Author(s):  
Ashley M Welsh ◽  
William S Dewey ◽  
James C Casey ◽  
Kyle B Cunningham
Keyword(s):  
Burn Injury ◽  
Treatment Time ◽  
Healing Process ◽  
Skin Grafting ◽  
The Body ◽  
Patient Acuity ◽  
Burn Scar ◽  
Dorsal Aspect ◽  
Dorsal Hand ◽  
Significant Difference

Abstract Introduction Hands are the most common area of the body to sustain a burn injury. Maintaining motion and function throughout the healing process of a burn injury is one of the most important goals of the rehabilitation process. After a deep burn to the dorsal aspect of the hand requiring skin grafting, the adjacent metacarpophalangeal (MCP) joints are at risk for developing a burn scar contracture (BSC), limiting the joints’ ability to fully flex towards a fist position. Post-operative positioning protocols state that patient’s hand should be temporarily immobilized for graft protection. A resting hand splint is used to maintain the wrist in approximately 20–30 degrees of extension, MCP joints at approximately 50–70 degrees of flexion and the interphalangeal joints in full extension. The purpose of this study was to assess the benefit of splinting as a treatment intervention to prevent MCP joint extension contractures following dorsal hand skin grafting. Methods This was a retrospective review of prospectively collected observational data from the “Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes” (ACT) study. Patients were included with grafted dorsal hand burns occurring within 1 of the 4 established cutaneous functional units (CFU) along the dorsal aspect of the second through fifth metacarpals. Since most subjects had more than one dorsal hand CFU involved, the number of CFUs were analyzed as opposed to the number of subjects. Isolated MCP joint flexion measurements were utilized to determine incidence of contracture. Included causes of contracture were scar tissue or other soft tissue limitations. Data were then analyzed by two groups: contracted and non-contracted. Results A total of 221 dorsal hand CFUs were included in this study; 119 contracted and 102 non-contracted. There was no statistical significant difference between the average splint wear time between the 2 groups. The average percent of affected CFUs grafted within the contracted group was 92.4% compared to 76.8% in the non-contracted group. In burns to the dorsal hand with less than 99% of the CFU grafted, splinting was effective in preventing 60% of MCP joint extension contractures. When greater than 99% of affected CFU was grafted, splinting was effective in prevention only 36% of contractures. Conclusions Splinting can be an effective intervention option in preventing MCP extension contractures when less than 75% of the affected CFU has been grafted; however, its effectiveness decreases as the percentage of CFU involvement increases to greater than or equal to 99%. Applicability of Research to Practice Determine most effective post-operative rehabilitations plan following dorsal hand skin grafts.

Technical keys in maximizing finger proximal interphalangeal joint motion after vascularized toe joint transfers

2019 ◽  
Vol 44 (7) ◽  
pp. 667-675 ◽  
Author(s):  
Yu-Te Lin
Keyword(s):  
Range Of Motion ◽  
Skin Flap ◽  
Surgical Techniques ◽  
Extensor Tendon ◽  
Limited Range ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Motion ◽  
Limited Range Of Motion ◽  
Central Slip

Vascularized toe joint transfers to the fingers have been performed for more than four decades, but their outcomes are not comparable with implant arthroplasty. Limited range of motion and extensor deficits of about 30° remain major problems with the constructed joints. We observed that the central extensor tendon of the toe is often attenuated proximally in its course on the dorsum of the proximal interphalangeal joint. A tight repair of the toe extensors to finger extensors limits joint motion. We reviewed our surgical techniques with this consideration. Thirty-eight fingers that we followed for 6 to 123 months had active range of motion of the reconstructed proximal interphalangeal joint in the finger of 58° (range 17°–76°) with an extensor deficit of 18° (range 0°–30°). We consider that the extensor mechanism and central slip insertion to the middle phalanx must be reconstructed meticulously to improve joint motion and decrease extension lag, and design of a lateral skin flap paddle to better cover vessels and allow extensor repairs.

scholarly journals Symptoms and their Relationship to Disability Following Treatment for Lower Extremity Tumours

Sarcoma ◽  
1999 ◽  
Vol 3 (2) ◽  
pp. 73-77 ◽  
Author(s):  
Aileen M. Davis ◽  
Sajeevan Punniyamoorthy ◽  
Anthony M. Griffin ◽  
Jay S. Wunder ◽  
Robert S. Bell
Keyword(s):  
Lower Extremity ◽  
Physical Disability ◽  
Univariate Analysis ◽  
Limited Range ◽  
Post Surgery ◽  
Limited Range Of Motion ◽  
Toronto Extremity Salvage Score ◽  
The Relationship ◽  
Over Time ◽  
Limited Motion

Purpose.The aims of this study were to describe the symptoms experienced by patients in the first year following treatment for lower extremity sarcoma by limb conservation and to describe the relationship between symptoms and physical disability.Subjects.Eighty consecutive patients treated for primary bone or soft tissue sarcoma (STS) of the lower limb who were treated with limb preservation surgery.Methods.Subjects were evaluated by questionnaire at 6 weeks, and 3, 6, and 12 months post surgery. They identified whether they experienced any of the following symptoms: pain, stiffness, fatigue, weakness, limited range of motion, or swelling.The Toronto Extremity Salvage Score (TESS), a measure of physical disability, was also completed. Frequency of symptoms over time was calculated and change was evaluated using the Cochrane test. The relationship of symptoms to disability was analyzed with regression methods.Results.The mean age was 43.0, SD=20.4 with a gender ratio of 1:1. There were 38 bone tumours and 42 STS.The most frequently reported symptoms were: stiffness 48 (60%), weakness 41 (51%), fatigue 26 (33%), and pain 25 (31%) at 6 weeks. Stiffness and fatigue decreased and plateaued by 3 months. Complaints of weakness and pain continued to decrease over time. At 6 weeks, pain, stiffness, weakness and limited motion predicted disability in both univariate and multivariate analyses. At 12 months, pain, stiffness, fatigue, weakness and limited motion were significant predictors of the TESS in univariate analysis with only pain, stiffness and limited motion significant predictors in the multivariate model.Discussion.Pain, stiffness, fatigue, weakness and limited motion are common symptoms with stiffness and weakness decreasing significantly over time. The symptoms predictive of disability differ between the acute and late phases of recovery.

scholarly journals The Characteristics Of Impaired Physical Mobility Among Patients With Stroke

2019 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
I Gede Purnawinadi
Keyword(s):  
Slow Motion ◽  
Limited Range ◽  
Stroke Patients ◽  
Related Factors ◽  
Clinical Indicators ◽  
Physical Mobility ◽  
Nursing Diagnosis ◽  
Limited Range Of Motion ◽  
Patient Documentation ◽  
Nursing Diagnoses

A valid nursing diagnosis is very important in nursing care. Clinical indicators are required to validate nursing diagnoses to reduce the risk of misdiagnosis. The accuracy of clinical indicators is determined by the limitation of characteristics and related factors. The purpose of this study was to describe the characteristics nursing diagnosis of impaired physical mobility. This research was a descriptive study conducted by assessment through observation in clinical practice. There were 20 records of stroke patient documentation used in this study. The results showed that the limitations of the main characteristics that emerged in stroke patients were dyspnea after activity (90%), gait disorder (100%), slow motion (100%), spastic movements (100%), uncoordinated movements (100%), posture instability (100%), difficulty flipping position (100%), limited range of motion (100%), discomfort (100 %), decreased fine motoric skills (90%), decreased gross motoric skills (100%), and moving tremor (90%). Nurses are expected to focus on main characteristics that arise during the assessment of stroke patients with nursing diagnoses of impaired physical mobility in order to plan effective nursing actions. For further investigators it is recommended to use valid instruments in conducting the assessment so that these characteristics can be a more accurate indicator in nursing diagnosis.

Impairment Tutorial: Rating Tears of the Acetabular Labrum

2006 ◽  
Vol 11 (6) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Richard E. Strain ◽  
James B. Talmage
Keyword(s):  
Magnetic Resonance ◽  
Hip Arthroscopy ◽  
Age Groups ◽  
Limited Range ◽  
Labral Repair ◽  
X Rays ◽  
Joint Stability ◽  
Acetabular Labrum ◽  
Complete Excision ◽  
Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

The Correlation of the Limitations of Movement of the Shoulder Joint with the Functional Ability of Frozen Shoulder Patients at the Medical Rehabilitation Institute Dr. Mohammad Hoesin Palembang

2020 ◽  
Vol 3 (3) ◽  
pp. 88-96
Author(s):  
Ine Sintia ◽  
Nyimas Fatimah
Keyword(s):  
Functional Ability ◽  
Shoulder Joint ◽  
Frozen Shoulder ◽  
Limited Range ◽  
Medical Rehabilitation ◽  
Cross Sectional ◽  
Shoulder Joints ◽  
Limited Range Of Motion ◽  
Active Flexion ◽  
Cross Sectional Design

Background: Frozen shoulder is a condition of the shoulder joint that experiences inflammation, pain, adhesions, atrophyand shortening of the joint capsule resulting in limited motion. In frozen shoulder patients, the limited range of motion ofthe shoulder joint can affect and reduce functional ability. This study aims to analyze the correlation between the limitedarea of motion of the shoulder joint with the functional ability of frozen shoulder patients at the Medical RehabilitationInstallation Dr. Mohammad Hoesin Palembang. Methods: This study was an observational analytic study, correlationtest, with a cross sectional design. There were 29 frozen shoulder patients who met the inclusion criteria in the MedicalRehabilitation Installation Dr. Mohammad Hoesin Palembang in November 2018 was taken as a sample using consecutivesampling techniques. Functional ability was assessed using the quickDASH questionnaire and the area of motion wasmeasured using a goniometer, then analyzed. Results: The results of the correlation test showed significant resultsbetween functional abilities and the area of motion of the shoulder joints. Active flexion (p = 0.000; r = -0.669), activeextension (p = 0.004; r = -0.520), active abduction (p = 0.000; r = -0.663), active adduction (p = 0.022; r = -0.423 ), passiveflexion (p = 0.001; r = -0.589), passive extension (p = 0.002; r = -0.543), passive abduction (p = 0.000; r = -0.676), passiveadduction (p = 0.038; r = -0.388). Conclusion: There is a significant correlation between limited joint motion andfunctional ability in frozen shoulder patients at the Medical Rehabilitation Installation of Dr. Mohammad HoesinPalembang

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